Pharmacy Technician Update NABPAACP District Five 73 rd

Pharmacy Technician Update NABP/AACP District Five 73 rd Annual Meeting Friday, August 6, 2010 Lloyd K. Jessen, Executive Director Iowa Board of Pharmacy 1

Definition of Pharmacy Technician NABP Model State Pharmacy Act • • • “Pharmacy Technician” means personnel registered with the Board who may, under the supervision of the pharmacist, assist in the pharmacy and perform such functions as: (1) assisting in the Dispensing process; (2) processing of medical coverage claims; (3) stocking of medications; and (4) cashiering 2

Definition of Certified Pharmacy Technician NABP Model State Pharmacy Act • “Certified Pharmacy Technician” means personnel registered with the Board who have completed a certification program approved by the Board and may, under the supervision of a Pharmacist, perform certain activities involved in the Practice of Pharmacy, such as: • (1) receiving new Prescription Drug Orders; • (2) prescription transfer; • (3) compounding; and • (4) assisting in the Dispensing process 3

NABP Model State Pharmacy Act • Section 105(n). Comment. • A Certified Pharmacy Technician is recognized, because of the completion of a board-approved certification program, as having knowledge and skills that qualify them to assist the pharmacist in the practice of pharmacy with limited patient care tasks that exceed routine dispensing or drug storage activities. 4

NABP Model State Pharmacy Act • Section 308. Registration of Pharmacy Technicians. • (a) In order to be registered as a pharmacy technician in this State, an applicant shall: … • (5) have been documented by the pharmacist-incharge of the pharmacy where the applicant is employed as having successfully completed a training program and having successfully completed an objective assessment mechanism prepared in accordance with any rules established by the Board. 5

NABP Model State Pharmacy Act • Section 307. Registration of Certified Pharmacy Technicians. • (a) In order to be registered as a certified pharmacy technician in this State, an applicant shall: … • (4) have: (i) graduated from a pharmacy technician training program approved by the Board of Pharmacy; or (ii) been documented by the pharmacist -in-charge of the pharmacy where the applicant is employed as having successfully completed a training program and having successfully completed an objective assessment mechanism prepared in accordance with any rules established by the Board; • (5) have successfully passed an examination or examinations approved by the Board of Pharmacy; 6

NABP Model State Pharmacy Act Section 307(b) and 308(b). Comment. The state may decide to perform a criminal background check on individuals seeking to register as certified pharmacy technicians or pharmacy technicians. 7

NABP Model State Pharmacy Act • Section 2. Personnel. • A. Duties and responsibilities of the pharmacist-in-charge… (3) The pharmacist-in-charge shall be assisted by a sufficient number of pharmacists, certified pharmacy technicians, and pharmacy technicians as may be required to competently and safely provide pharmacy services…. 8

NABP Model State Pharmacy Act (b) The pharmacist-in-charge shall develop and implement written policies and procedures to specify the duties to be performed by certified pharmacy technicians and pharmacy technicians. The duties and responsibilities of these personnel shall be consistent with their training and experience. 9

NABP Model State Pharmacy Act These policies and procedures shall, at a minimum, specify that certified pharmacy technicians and pharmacy technicians are to be personally and directly supervised by a pharmacist stationed within the same work area who has the ability to control and who is responsible for the activities of certified pharmacy technicians and pharmacy technicians. . . 10

NABP Model State Pharmacy Act Such policies and procedures shall also specify that pharmacy technicians shall not be assigned duties that may be performed only by certified pharmacy technicians. 11

NABP Resolution No. 106 -7 -10* Continued Efforts to Standardize Pharmacy Technican Education & Training Programs *Passed at the NABP 106 th Annual Meeting, Anaheim, CA 12

NABP Resolution No. 106 -7 -10 Whereas, new pharmacy technician education and training programs are being established in community colleges and trade schools across the country; and Whereas, no nationally recognized, uniform standards are currently in place in each state to guide the quality and appropriateness of the course curriculum of such programs; and Whereas, state boards of pharmacy have a responsibility to oversee the training and practice of pharmacy technicians in the interest of the public health and safety; THEREFORE BE IT RESOLVED that NABP continue to encourage states to adopt uniform standards for pharmacy technician education and training programs. 13

NABP Task Force on Pharmacy Technician Education and Training Programs* Eight Recommendations *Task Force met on October 6 -7, 2009. Two members of District Five participated on the task force: Kevin Borcher (NE) and Earl Mc. Kinstry (SD). 14

NABP Task Force on Pharmacy Technician Education and Training Programs* Recommendation # 1: NABP should encourage boards of pharmacy to require as an element of pharmacy technician certification completion of an education and training program that meets minimum standardized guidelines. 15

NABP Task Force on Pharmacy Technician Education and Training Programs* Recommendation # 2: NABP should encourage boards of pharmacy to require as an element of pharmacy technician certification completion of an accredited education and training program by 2015. 16

NABP Task Force on Pharmacy Technician Education and Training Programs* Recommendation # 3: NABP should assist in developing a national accreditation system for pharmacy technician education and training programs that is based within the profession of pharmacy and utilizes a single accrediting agency by 2015. 17

NABP Task Force on Pharmacy Technician Education and Training Programs* Recommendation # 4: NABP should commission a standing committee to develop and maintain national standards for pharmacy practice to assist boards in defining the evolving roles of pharmacists and pharmacy technicians and technician education and training program standards. (Not implemented by Executive Committee) 18

NABP Task Force on Pharmacy Technician Education and Training Programs* Recommendation # 5: NABP should encourage ACPE and ASHP to work collaboratively to develop an accreditation system for pharmacy technician education and training programs that reflects all pharmacy practice settings and, if feasible, to consolidate the activities into one accrediting body, preferably ACPE. 19

NABP Task Force on Pharmacy Technician Education and Training Programs* Recommendation # 6: NABP should encourage PTCB to change the process by which it determines who is qualified to sit for its examination to include completion of an accredited pharmacy technician education and training program and high school diploma or GED verification. 20

NABP Task Force on Pharmacy Technician Education and Training Programs* Recommendation # 7: NABP should encourage PTCB to provide NABP with information on its certified pharmacy technicians so that NABP may enhance the pharmacy technician data contained in the NABP clearinghouse to provide the information necessary for the state boards of pharmacy to protect the public health. 21

NABP Task Force on Pharmacy Technician Education and Training Programs* Recommendation # 8: NABP should encourage ASHP to revise its current accreditation standards for pharmacy technician education and training programs to require accredited providers to inform potential program applicants of applicable state requirements for registration or licensure. 22

53 U. S. Jurisdictions • 50 U. S. States plus District of Columbia, Guam, and Puerto Rico • Source: NABP 2010 Summary of Pharmacy Law • Census data as of June 30, 2009 • Great variation in technician provisions among U. S. jurisdictions • State regulations are in a state of flux • Still little uniformity 23

43 Jurisdictions (81%) License, Register, or Certify Pharmacy Technicians & Guam & Puerto Rico 24

10 Jurisdictions (19%) Have No Pharmacy Technician Provisions* & District of Columbia *Note: Ohio now defines “qualified” technicians 25

USA Regulated vs. Unregulated • The 43 U. S. jurisdictions that regulate pharmacy technicians represent 75% of the U. S. population. • The 10 U. S. jurisdictions that do not regulate technicians represent 25% of the U. S. population 26

# of Technicians in 39 U. S. States 317, 410 (# of technicians unknown in Colorado, Delaware, District of Columbia, Florida, Georgia, Guam, Hawaii, Kentucky, Michigan, New York, Ohio, Pennsylvania, South Carolina and Wisconsin) 27

Total # of Pharmacies in 39 U. S. States 54, 693 28

U. S. Average 6 pharmacy technicians per pharmacy 29

Pharmacy Technician Certification Board § The Pharmacy Technician Certification Examination (PTCE) has been available since 1995. § 485, 868 persons have sat for the PTCE § Overall passing rate has been 75% § Passing rate for January—March 2010 testing period was 74%. 30

Pharmacy Technician Certification Board Total # of PTCB-certified pharmacy technicians in the U. S. (as of March 2010) 365, 571 31

Pharmacy Technician Certification Board Total # of Actively-certified PTCB technicians in the U. S. (as of March 31, 2010) 235, 652 32

Pharmacy Technician Certification Board # of PTCB technicians in the U. S. who have not maintained their certification 129, 919 (36% of total) 33

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PTCB Techs in District Five 35

ICPT Approved, Recognized or Accepted by 24 Boards of Pharmacy ICPT “approved” in: Alabama, Connecticut, Delaware, Idaho, Indiana, Iowa, Kansas, Kentucky, Maryland, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, Oregon, Rhode Island, Tennessee, Utah, and Virginia. ICPT “recognized” in: Illinois, Nevada, New Hampshire, and Washington ICPT “accepted” in: Ohio ICPT = The Institute for the Certification of Pharmacy Technicians Ex. CPT = Exam for the Certification of Pharmacy Technicians ICPT is recognized by NCPA and NACDS. 36

2 States (Red) With No Tech Regs Recognize the PTCB 37

# of PTCB Technicians in States With No Tech Regs Total = 43, 729 • • • Colorado Delaware District of Columbia Georgia Hawaii Michigan New York • Pennsylvania • Ohio • Wisconsin 4, 383 742 202 6, 738 643 6, 764 5, 673 5, 946 8, 466 4, 172 38

43 Jurisdictions License, Register, or Certify Pharmacy Technicians 3 4 29 5 2 Puerto Rico = Red Guam = Green Blue = Certify Red = Certify & Register Green = Register Gold = License Black = License & Register White = No Regs 39

8 U. S. Jurisdictions That Require Certification of Pharmacy Technicians & Puerto Rico 40

18 U. S. Jurisdictions That Don’t Require Technician Training & Dist. Of Columbia 41

17 U. S. Jurisdictions Have No R. Ph. /Technician Ratios & Puerto Rico 42

10 U. S. Jurisdictions Allow Techs to Accept Called-in Rx from Prescriber & Dist. Of Columbia 43

10 U. S. States Allow Tech-Check-Tech in Institutional Setting coming 44

4 U. S. States Allow Tech-Check-Tech in Community Setting 45

17 U. S. States Require Continuing Ed for Technicians 46

19 U. S. States Require A Technician Examination 47

Pharmacy Technicians in Iowa Ø # of registered techs since 1998: 15, 538 Ø # of total current registered techs = 4, 506 (29%) Ø # of cancelled/delinquent techs = 11, 032 (71%) 48

Pharmacy Technicians in Iowa Ø # of active PTCB-cert techs = 2, 747 (61%) Ø # of active ICPT-cert techs = 723 (16%) Ø # of total active certified techs = 3, 470 (77%) Ø # of uncertified technicians = 292 (7%) Ø # of technician trainees = 728 (16%) 49

Pharmacies & Pharmacists in Iowa Ø # of current/active pharmacists = 3, 292 Ø # of licensed pharmacies = 941 Ø Iowa average = 4. 8 techs per pharmacy Ø Iowa average = 1. 4 technicians per R. Ph. 50

Pharmacy Supportive Personnel (PSP) in Iowa Ø # of current/active PSPs = 746 Ø Iowa average = 0. 8 PSPs per pharmacy Ø Iowa average = 0. 2 PSPs per R. Ph. 51

Pharmacy Technicians in North Carolina Proposed Rule: Pharmacy technicians who work in an acute-care hospital and hold an associate’s degree in pharmacy technology may provide greater assistance to pharmacists in the areas of unit-dose packaging and certain unit-, cart-, and floor-stocking. 52

Public Perceptions About Pharmacy Technicians* 73% of the public believes that pharmacy technicians are required by law to be trained and certified before they can help prepare prescriptions. *Telephone survey of 1, 010 adults on Nov. 16 -19, 2007, sponsored by PTCB. 53

Public Perceptions About Pharmacy Technicians* 58% of the public believes that only licensed pharmacists are involved in dispensing drug prescriptions. *Telephone survey of 1, 010 adults on Nov. 16 -19, 2007, sponsored by PTCB. 54

Public Perceptions About Pharmacy Technicians* 45% of the public do not believe that people without formal training are allowed to help pharmacists prepare prescriptions for patients. *Telephone survey of 1, 010 adults on Nov. 16 -19, 2007, sponsored by PTCB. 55

Public Opinion About Pharmacy Technician Regulations* 91% of the public supports state regulations that require the training and certification of pharmacy technicians. *Telephone survey of 1, 010 adults on Nov. 16 -19, 2007, sponsored by PTCB. 56

Pharmacist Opinion About Certified Pharmacy Technicians* 81% of pharmacists agree that certified pharmacy technicians play a role in reducing medication errors. *Gathered from a random sample of over 3, 250 U. S. pharmacists, sponsored by PTCB and reported at the APh. A Annual Meeting in March 2010. 57

Workforce Data Significant Trends Affecting the Pharmacist Workforce Presented at 2009 NACDS Pharmacy & Technology Conference Boston, MA, August 9, 2009 Presented by: Midwest Pharmacist Workforce Research Consortium (MPWRC) Jon C. Schommer, Ph. D. William R. Doucette, Ph. D. Caroline A. Gaither, Ph. D. David H. Kreling, Ph. D. David A. Mott, Ph. D. 58

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Workforce Data* Projected Employment 2018 Change 2008 -2018 # % Pharmacy Aides 54, 900 51, 500 -3, 500 -6 Pharmacy Techs 326, 300 426, 000 99, 800 31 Combined 477, 500 96, 300 25 Occupation Title Employment 2008 381, 200 *U. S. Dept. of Labor, Bureau of Labor Statistics, Occupational Outlook Handbook, 2010 -11 Edition 63

Workforce Data* Pharmacy Technician—Median Hourly Wage as of May 2008: $13. 32 Range: < $9. 27 to > $18. 98 Pharmacy Aide—Median Hourly Wage as of May 2008: $9. 66 Range: <$7. 69 to > $14. 26 *U. S. Dept. of Labor, Bureau of Labor Statistics, Occupational Outlook Handbook, 2010 -11 Edition 64

Workforce Data* From 2009 to 2018, the number of pharmacists in the U. S. is expected to increase by 45, 900 or 17% (from 267, 000 to 312, 900). *Fact Sheet 2010, “Pharmacists and Pharmacy Technicians: Facts and Figures, ” AFL-CIO Department of Professional Employees (based on “Occupational Employment Projections to 2018” by Alan T. Lacey and Benjamin Wright, Monthly Labor Review, November 2009; and U. S. Dept. of Labor, Bureau of Labor Statistics, Current Population Survey, Table 11, 2010). 65

Workforce Data* In 2008, the median annual earnings for pharmacists were $106, 410. Range: <$77, 390 to > $119, 480 *Fact Sheet 2010, “Pharmacists and Pharmacy Technicians: Facts and Figures, ” AFL-CIO Department of Professional Employees (based on U. S. Dept. of Labor, Bureau of Labor Statistics, Occupational Employment and Wages, 2008). 66

The Need for Technician Standardization and Uniformity →One level of technicians? →Two or three or more levels? →Certified or Uncertified? →Licensed or Registered? →Pharmacy Aides or Support Persons? 67

The Need for Technician Standardization and Uniformity →Formal technician training or O-T-J? →Accredited education programs? →One competency exam? →Multiple exams? →Reciprocity for Technicians? →Pharmacist-to-Technician Ratios? →Tech-Check-Tech and other expanded duties? 68

The Need for Technician Standardization and Uniformity →Perception vs. Reality? →Shifting of pharmacist tasks to technicians? →Differences in Work Settings (Retail vs. Institutional)? →Worker Shortages? →Job Dissatisfaction & High Turnover Rate? →Monetary Issues (Profit Margin vs. Safety)? →Effect of Technology/Robotics/Kiosks? 69

Pharmacy Technician Update Discussion and Q&A 70